Basic Information
| Provider Information | |||||||||
| NPI: | 1629242599 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NAPA SKILLED NURSING CENTER | ||||||||
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| OtherOrganizationName: | NAZARETH SKILLED NURSING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 S B ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944014272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503479500 | ||||||||
| FaxNumber: | 6503479400 | ||||||||
| Practice Location | |||||||||
| Address1: | 2465 REDWOOD RD | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945583103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072553012 | ||||||||
| FaxNumber: | 7072551015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2008 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | HANHAN | ||||||||
| AuthorizedOfficialFirstName: | HANNA | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6503479500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | ZZR05549K | 05 | CA | MEDICAID |